The role and scope of the clinical nurse consultant in Wentworth area health service, New South Wales, Australia

Finnish Version of the Specialist Outcomes and Barriers Analysis Scale: Evaluation of Psychometric Properties

PURPOSE

To evaluate the psychometric properties of the Finnish version of the Specialist Outcomes and Barriers Analysis Scale.

DESIGN

This was a cross-sectional survey study.

METHODS

Cultural adaptation of the translation and content validity of the translated instrument were assessed by expert panelists (n = 5) using the content validity index. The construct validity was assessed with principal component analysis using the survey data of Finnish registered nurses (n = 60). Scale reliability was assessed with Cronbach's α values. All study phases were conducted in 2021.

RESULTS

The items (n = 59) of the scale were critically evaluated by the experts. The full-scale content validity was revealed as excellent (0.92). In terms of construct validity, the scale was analyzed separately for outcomes and barriers. The outcomes section revealed a 5-component structure with an overall Cronbach's α coefficient of .96, and the barriers section, a 2-component structure with an overall Cronbach's α coefficient of .82, indicating adequate reliability of the scale.

CONCLUSION

The Finnish version of the scale showed excellent content and construct validity. The Cronbach's α values represented adequate reliability of the Specialist Outcomes and Barriers Analysis scale when measuring nurses' perceived practice outcomes and barriers in the Finnish context.

Clarifying Clinical Nurse Consultant work in Australia: A phenomenological study

The Clinical Nurse Consultant role in Australia is an Advanced Practice Registered Nurse Role (APRN). This role has been conceptualized from the discrete pillars of research, education, practice, system support and leadership, articulated in the Strong Model of Advanced Practice. This conceptualization has been manifested in job descriptions, workforce. planning and course design. This paper explored whether there was a more refined way of conceptualizing the unique 'value add' of the role. A hermeneutic phenomenological approach was employed to explore the lived experience of the role. It was identified that the pillars of education, practice, leadership and research are interconnected and expressed in the system work of the Clinical Nurse Consultant. The findings have implications for education and workforce planning.

The role of a clinical nurse consultant in an Australian Health District: a quantitative survey

Background

This study replicates previous research undertaken in 2013 that explored the role of the Clinical Nurse Consultant in a metropolitan health district in Sydney, Australia.

Methods

A descriptive survey, using Likert scales, was used to collect data from Clinical Nurse Consultants.

Results

Clinical Nurse Consultants are well informed about the domains and functions of their role, as stipulated in the relevant award. They identified clinical service and consultancy as the area in which they predominantly practice.

Conclusion

Despite the clarity of the domains and functions as outlined in the relevant legislated award, the activities undertaken by these clinical nurses are institutionally, individually and contextually constructed.

Recognising the differences in the nurse consultant role across context: a study protocol

Background

The advanced practice role of the Nurse Consultant is unique in its capacity to provide clinical leadership across a range of contexts. However, the Nurse Consultant role has been plagued with confusion due to lack of clarity over function and appropriateness for purpose within health organisations across contexts. Changing health service delivery models are driving the emergence of new nursing roles, further clouding the waters related to role positioning and purpose. There is an urgent need for evidence of impact and demonstration of how Nurse Consultants contribute to health care outcomes. This study aims to gain a clearer understanding of the Nurse Consultant role and its impact in metropolitan and rural New South Wales (NSW) Australia.

Design

The proposed study employs a sequential mixed method design, underpinned by Realistic Evaluation, to explore how Nurse Consultants contribute to organisational outcomes. The ‘context – mechanism – outcome’ approach of realistic evaluation provides a sound framework to examine the complex, diverse and multifaceted nature of the Nurse Consultant’s role.

Method

Participants will be stakeholders, recruited across a large Local Health District in NSW, comprising rural and metropolitan services. A modified and previously validated survey will be used providing information related to role characteristics, patterns and differences across health context. Focus groups with Nurse Consultant’s explore issues highlighted in the survey data. Focus groups with other clinicians, policy makers and managers will help to achieve understanding of how the role is viewed and enacted across a range of groups and contexts.

Discussion

Lack of role clarity is highlighted extensively in international and Australian studies examining the role of the Nurse Consultant. Previous studies failed to adequately examine the role in the context of integrated and complex health services or to examine the role in detail. Such examination is critical in order to understand the significance of the role and to ascertain how Nurse Consultants can be most effective as members of the health care team. This is the first Australian study to include extensive stakeholder perspectives in order to understand the relational and integrated nature and impact of the role across metropolitan and rural context.

A qualitative study on the roles and responsibilities of nurse consultants in Hong Kong

This study aims to explore the roles and responsibilities of seven newly appointed nurse consultants (NCs) in various clinical specialties in Hong Kong as a pioneer project. Qualitative approaches using direct observation and semi-structured interviews were adopted with two full-day observations on the seven NCs plus 56 semi-structured interviews of NCs, nurses, doctors and patients. Five major NCs' roles and responsibilities had been identified, namely providing expert practice, initiating service development, leading education, guiding continuous quality improvement (CQI) and conducting research and providing evidence-based practice. The seven NCs within this study have by and large achieved building professional excellence, respect and trust within their own spheres. It is strongly recommended that the NC post be formally established in the new Nurses Career Structure to enable expert clinical nurses to develop a clinical career to contribute to service and patient care to its maximum.

Developing a culture to facilitate research capacity building for clinical nurse consultants in generalist paediatric practice

This paper reports a research capacity building exercise with a group of CNCs practicing in the speciality of paediatrics in New South Wales (NSW), Australia. It explores the first step in building a research culture, through identifying the research priorities of members of the NSW Child Health Networks Paediatric Clinical Nurse Consultant group, and this forms the major focus of this paper. A nominal group technique (NGT) was utilised with sixteen members to identify research topics for investigation which were considered a priority for improving children's health care. The group reviewed and prioritised 43 research topics in children's health which were identified in the literature. As a result of conducting this research prioritisation exercise, the group chose two research topics to investigate: reasons for children representing to the Emergency Department and a comparison of the use of high-flow and low-flow nasal prongs in children with bronchiolitis. The research team will continue to mentor the nurses throughout their research projects which resulted from the NGT. One bridge to leadership development in enhancing patient care is translating knowledge to practice and policy development. This study leads the way for a group of CNCs in paediatric nursing to combine their research capacity and influence clinical knowledge.

Advanced nursing roles: a systematic review

In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible.

Development of a tool to describe the role of the clinical nurse consultant in Australia

AIMS AND OBJECTIVES

To develop a tool for defining and measuring the role characteristics and responsibilities of an advanced practice nursing role in Australia.

BACKGROUND

Internationally, there is considerable confusion about the precise role responsibilities of advanced practice nursing positions. In Australia, the clinical nurse consultant is an advanced practice role with five nominated domains of practice. However, there are no tools for measuring the performance of clinical nurse consultants against the listed domains.

DESIGN AND METHODS

Participants were 56 clinical nurse consultants at a tertiary public hospital. The existing literature, an online survey, and position descriptions were used to generate the a priori themes for the initial template. Semi-structured interviews were conducted (in 2010) to test the template characteristics. The template underwent multiple iterations in its development.

RESULTS

A 50-item tool was devised, which consisted of five domains with a ten-point hierarchical scale within each domain. In preliminary testing, the revised template was found to provide greater clarity regarding roles and grades than the original position descriptions.

CONCLUSIONS

Further testing and refinement of the modified rating scale is needed, but it offers the possibility of a new tool that can be used by health service managers to determine the grade of a clinical nurse consultant position and for evaluating role performance.

RELEVANCE TO CLINICAL PRACTICE

This preliminary study suggests that the tool provides a useful means of measuring advanced nursing practice and responsibilities across different domains and levels of appointment. The tool may be able to be adapted for use with other advanced practice nursing roles both within Australia and internationally.

Measuring actual scope of nursing practice: a new tool for nurse leaders

OBJECTIVE

: This project describes the development and testing of the actual scope of nursing practice questionnaire.

BACKGROUND

: Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope.

METHODS

: Literature review, expert consultation, and face validity testing were used in item development. The instrument was tested with 285 nurses in 22 medical units in 11 hospitals in Canada.

RESULTS

: The 26-item, 6-dimension questionnaire demonstrated validity and reliability. The responses suggest that nurses practice at less than their optimal scope, with key dimensions of professional practice being implemented infrequently.

CONCLUSIONS

: This instrument can help nurse leaders increase the effective use of RN time in carrying out the full scope of their professional practice.

Daring to be different: a qualitative study exploring the education needs of the nurse consultant

Nurse consultants are recognised experts and are one of the most senior nursing 'clinical' grades. How these roles have developed has varied but all require an armoury of expanded and extended skills. However, since their introduction in the UK little has been written about how they should be effectively prepared for the role. This study used a multi-method approach to establish a rich picture of the nurse consultant role (specialising in safeguarding children) in relation to their existing skills and perceived education needs. The job descriptions and specifications of a sample of consultant nurses (n=4) established role expectations and content, whilst in-depth individual semi-structured interviews with the nurses and six key 'stakeholders' explored perspectives about the educational preparation and ongoing learning needs of those either in the role or aspiring to be. The findings suggest that whilst there are differences there is also some convergence in their developmental needs. For example, that mentorship and academic and leadership support were integral to meeting their learning needs, to optimise effectiveness and to enhance future role development. It is vital therefore that those wishing to 'grow' consultant nurses implement a range of educational strategies to support the continued professional and clinical development of current and future post holders.

Being an effective nurse consultant in the English National Health Service: what does it take? A study of consultants specializing in safeguarding

AIMS

This study established key attributes and perceived strengths, weaknesses, opportunities and threats (SWOT) of nurse consultants specializing in safeguarding children.

BACKGROUND

The nurse consultant role in England spans four domains--clinical, leadership, education and research--and was intended to enable senior nurses to remain in clinical practice.

METHOD

ata identifying the time spent by the nurse consultants in the four domains was collated and a thematic content analysis of the SWOT of the role was ascertained from semi-structured interviews with nurse consultants (n = 4) and stakeholders (n = 6).

RESULTS

Strengths and opportunities in clinical (consultancy), leadership and educational functions were identified but some weaknesses and threats in terms of nurse consultant's contributions to research were also identified. The role was neither wholly strategic nor clinical. Role ambiguity meant that they were not always valued by managers, making the role potentially expendable.

CONCLUSIONS

Nurse consultants are pivotal within health-care organizations because they span clinical practice and leadership enabling them to support managers in strategic planning, commissioning and implementation of policy.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse consultants can support strategic practice development and influence quality and effectiveness service-wide. To succeed they must be understood, supported and nurtured by managers.

Supporting trail-blazing: A systematic review of the factors that facilitate or inhibit the implementation of new nursing roles: the experiences of UK consultant nurses

BACKGROUND

If emerging 'trail-blazers', such as the consultant nurse, are to be successful in developing and sustaining new ways of working then factors that support or inhibit new role developments need identification. There is a growing body of evaluative and anecdotal evidence about the experience of consultant nurses since the introduction of the role in the UK thirteen years ago.

OBJECTIVE

To synthesise the evidence on the experiences of UK consultant nurses in implementing a new role in order to identify inhibitors and facilitators of role development.

INCLUSION CRITERIA

This review sought qualitative and mixed methodology studies that yielded qualitative data about the phenomenon of interest, together with narrative opinion papers i.e. consultant nurses' experiences of role development.

SEARCH STRATEGY

The search in 14 databases considered studies and opinion papers published between January 1999 and April 2010 in English.

METHODOLOGICAL QUALITY

All retrieved studies and opinion papers were assessed by two independent reviewers using the standardised Joanna Briggs Institute critical appraisal tools.

DATA COLLECTION

Data were extracted from included papers using the standardised Joanna Briggs Institute data extraction tool.

DATA SYNTHESIS

Data synthesis used the Joanna Briggs Institute approach for meta-synthesis by meta-aggregation. Findings were synthesised into categories and categories were aggregated into synthesised findings.

RESULTS

On the basis of critical appraisal, no opinion papers were included in the review. A total of 11 qualitative studies were included, yielding a total of 313 findings. These were synthesised into 64 categories which were further synthesised into 11 synthesised findings about factors that facilitate and inhibit the role's implementation and development.

CONCLUSION

Drawing directly on consultant nurses' experiences, these findings add evidence to what is already known about what does and does not work in developing a consultant role. They indicate that an understanding about the role's core functions is needed, as is a supportive environment in which the consultant can fully operate.

IMPLICATIONS FOR PRACTICE

The implications for practice are derived from the results of the synthesised findings. An organisation, through its policies, practices, procedures and individuals, must support the consultant's leadership and collaborative goal directed approach to care delivery and service development. This can be achieved by allowing the consultant both autonomy and authority. The synthesised findings reinforce the need to optimise the facilitators and minimise the inhibitors of role development. They can also make a contribution to the conceptual understanding of the consultant role.

IMPLICATIONS FOR RESEARCH

Further research into the experiences of consultant nurses is necessary - in particular, how nurse consultants interpret their relationships with others, negotiate resources and demonstrate the impact of their role in each of the core functions, notably the leadership function.

The experience of being an advanced practice nurse in Australian acute care settings: A systematic review of qualitative evidence

BACKGROUND

There is a vast amount of international literature which, although agreeing on the need for advanced practice nurse roles, simultaneously debates and discusses the difficulties with nomenclature, definition and subsequent implementation of such roles. Due to this ambiguity it is difficult to equally compare evidence in this field across different countries. A context-specific systematic review on the qualitative evidence of the experience of being an advanced practice nurse in Australia has not been undertaken previously, however it is imperative for nursing managers and leaders to understand the complexities of advanced nursing roles in order to effectively utilise and retain these experienced and valuable nurses. With the creation of a national nursing regulating authority in 2010, it is timely to explore in-depth the experience of being an advanced practice nurse from a national perspective.

OBJECTIVE

To identify the experience of being an advanced practice nurse working in Australian acute care settings.

INCLUSION CRITERIA

Registered nurses working in advanced practice roles in acute care settings throughout Australia.The experience of being an advanced practice registered nurse working in an Australian acute care setting, as reported by the nurses themselves.Interpretive qualitative studies including designs such as phenomenology, grounded theory and ethnography.

SEARCH STRATEGY

A three step search strategy was used to identify published and unpublished studies. The search process was conducted from August to October 2011 and considered published and unpublished studies from 1990 to October 2011.

METHODOLOGICAL QUALITY

Studies were appraised for methodological quality by two independent reviewers using the Joanna Briggs Qualitative Assessment and Review Instrument.

DATA EXTRACTION

Data was extracted from the papers included in the review using the standardised Joanna Briggs Institute Qualitative Assessment and Review Instrument data extraction tool.

DATA SYNTHESIS

Research findings were pooled using the Joanna Briggs Institute Qualitative Data and Review Instrument.

RESULTS

Three published studies and one unpublished dissertation were included in the review. From these four studies, 216 findings were extracted, forming 18 categories which were then analysed to create six synthesised findings. Six meta-syntheses under the headings of expert knowledge, confidence, education, relationships, negative experiences and patient centred experience were formed from the findings.

CONCLUSIONS

The synthesised findings confirm that the experience of advanced practice nurses in Australian acute care settings is complex and greatly influenced personally and professionally by the organisation as well as the unpredictable nature of working with people.

IMPLICATIONS FOR PRACTICE

A deeper understanding of the essence of being an advanced practice nurse may be of benefit for recruitment and retention planning. Health care organisations must also be aware of the impact they have on the nurse's experience if they are to commit to retention of nurses and to patient safety.

IMPLICATIONS FOR RESEARCH

If the topic of advanced practice is to remain current in the Australian nursing profession then ongoing research must be conducted to identify if the title is being used more frequently within the nursing research. Nurses must be supported in publishing quality research if they are to improve articulation of their experiences.

Exploring the scope of expanding advanced nursing practice in nurse-led clinics: a multiple-case study

AIM

This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong.

BACKGROUND

Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice.

METHODS

A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted.

RESULTS

The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics.

CONCLUSION

The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond.

Evaluation of the impact of nurse consultant roles in the United Kingdom: a mixed method systematic literature review

AIM

This paper reports a mixed methods systematic review examining the impact of nurse consultant roles in adult healthcare settings, with a view to identifying indicators for demonstrating their impact on patient and professional outcomes.

BACKGROUND

Nurse consultants were introduced in England in 2000 with the intention to achieve better outcomes for patients by improving quality and services. Previous studies have investigated the impact of nurse consultants, but attempts to amalgamate this evidence have been methodologically limited. Since these reviews were published, the importance of demonstrating the contribution of nurse consultants has prompted new research. A robust review of the evidence is now required.

DATA SOURCES

A broad search strategy was adapted for eight databases. Grey literature was sought from various sources.

REVIEW METHODS

Quantitative and qualitative studies were included. Study quality was assessed using appropriate instruments. Cross-study synthesis combined the quantitative and qualitative findings in relation to the dimensions of impact identified. Measures of impact were mapped against a framework for assessing clinical and professional outcomes.

RESULTS

Thirty-six studies were included. The findings suggest a largely positive influence of nurse consultants on a range of clinical and professional outcomes, which map onto the proposed framework of impact. However, there was very little robust evidence and the methodological quality of studies was often weak.

CONCLUSION

Further robust research is required to explore nurse consultants' impact on patient and professional outcomes. The proposed framework for assessing impact could be used to guide future research and assist nurse consultants assess their impact.

Clinical nurse research consultant: a clinical and academic role to advance practice and the discipline of nursing

AIMS

This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role.

BACKGROUND

Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians.

DATA SOURCES

International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant.

DISCUSSION

The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus.

IMPLICATIONS FOR NURSING

Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support.

CONCLUSION

The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing.

An exploration of personal initiative theory in the role of consultant nurses

The aim in this paper is to investigate the contribution personal initiative theory makes in understanding the consultant nurse role. The role was introduced in the UK in 2000 to improve patient outcomes, clinical leadership and retention of experienced clinicians. A larger study used a multi-method approach to collect quantitative and qualitative data from focus groups, interviews and a questionnaire administered nationally at two time points. Findings from longitudinal telephone interviews with 30 consultant nurses are the focus of this paper.

Three consultant nurses were selected as case studies to examine the potential of personal initiative theory when applied to new nursing roles. The activities of two of the three demonstrated a high level of personal initiative in the job. They persisted in overcoming problems faced in improving practice. The third scored lower: she emerged as a reactive conformist and less likely than the other two to pursue initiatives of her own.

Personal initiative theory has potential as a framework for evaluating the consultant nurse role, although further research is needed to test it. The longitudinal analysis revealed a determination to stay in the job and overcome difficult challenges when consultants show initiative and are making progress in achieving change.

Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

AIMS

To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary.

BACKGROUND

Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role.

METHODS

A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100.

RESULTS

Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident.

CONCLUSION

The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.

How do CNCs construct their after hours support role in a major metropolitan hospital

AIM

To explore how CNCs who provide hospital wide support after hours (AHCSs) construct their role.

METHODS

This is an ethnographic study involving two AHCSs as participants. Audio visual data was collected in 2007 at a Major Metropolitan Hospital, Sydney during after hours shifts. The data was coded using the standards defined in the Nurse Practitioner (NP) competencies.

RESULTS

Four hours of videotape (observed clinical practice) and 2 h of audio tape (interviews) were coded. They performed procedures (22%), gathered information to identify at risk patients (21%), conducted patient assessments (20%) and relayed information/findings to ward nurses (12%) and doctors (12%). The roles/responsibilities of AHCSs were similar to those defined for NPs. For the domain "dynamic practice" 388 activities were identified. The two participants used advanced and comprehensive assessment skills and demonstrated a high level of proficiency in performing procedures/interventions. For the domain "professional efficacy" 174 activities were coded, for "clinical Leadership" there were 135 activities. "Pro-actively identifying at risk patients in general wards" was added as a new performance indicator within the domain "clinical leadership". An analysis of the interviews corroborated the results derived from the visual data.

CONCLUSION

A significant capacity for critical thinking and clinical decision making were the hallmarks of the performance of the two AHCSs; their style of practice was collaborative, flexible and autonomous. While their formal role were as CNCs the two participants operationalised their roles/responsibilities as would a Nurse Practitioner. Their practice demonstrated a new competency: "the pro-active identification of at risk patients".